Hadassah Medical Center in Israel recently began administering proton therapy to cancer patients who previously did not have had local access to the cutting edge treatment. Unlike conventional proton therapy systems, they are using P-Cure's gantry-less system, which provides personalized and adaptive intensity-modulated particle therapy in a seated position.

In order to learn more about what the treatment capabilities have meant for Hadassah, HCB News spoke to chief medical physicist, Dr. Jon Feldman, and head of oncology, Dr. Aron Propovtzer.

HCB News: When did you begin offering proton therapy at Hadassah Medical Center, and how was the decision made to provide it?
Dr. Aron Propovtzer: We began offering proton therapy at Hadassah Medical Center in early 2023, following a thorough and strategic process that began approximately five years ago. Our journey started when we became aware of the evolving technology in proton therapy, which significantly reduced the cost and size of traditional equipment. This led us to establish a collaboration with the Israeli company P-Cure, which was in the final stages of developing a compact and innovative system. Once P-Cure received FDA clearance, we moved into the clinical phase. Our proton therapy program was launched under research approved by the Ministry of Health, focusing on treating CNS, head and neck, thorax, and pancreatic conditions.

HCB News: Did you have prior experience with other proton systems? What was the learning curve like with the one you're using?
Dr. Jon Feldman: While we did not have prior hands-on experience with other proton systems, we conducted extensive research and studied various alternatives available in the market. Our primary criteria were clinical efficacy, economic viability, and the potential for future upgrades, particularly in areas like helium therapy, which we believe holds significant clinical value. Additionally, we were keen to contribute to the company's innovation by generating clinical value through adaptive and arc therapies and being actively involved in the future development of helium-based treatments. The learning curve with the system we selected was aligned with these goals, enabling us to implement advanced therapies effectively.

HCB News: You're utilizing a gantry-less system from P-Cure that treats patients in the seated position. How does the patient experience compare to conventional gantry-based systems?
AP: Our experience, along with recently published studies, shows that patients treated in the seated position using the gantry-less system from P-Cure generally report a more comfortable and less stressful experience compared to conventional gantry-based systems where patients are positioned supine. Patients have found it easier to breathe, and the seated position significantly reduces the risk of cardiac toxicity and allows for better saliva drainage. Additionally, we've observed that patients feel safer and more at ease in this position. Our published data also supports that the system maintains a high level of accuracy for both intra- and interfraction positioning, ensuring precise treatment delivery.

HCB News: How many patients are you seeing per day and what indications are you treating most frequently?
JF: Currently, we are treating up to 7 patients per day in a single shift as part of our ongoing study. Once the study is completed, we plan to expand to two shifts, which will allow us to treat at least 40 patients daily. The most common indications we are treating at the moment include head and neck, cranial, lung, and mediastinum cancers. We are also preparing to start treating pancreatic cancer, which we anticipate will require a significant portion of our treatment time.

HCB News: Proton therapy comes with a high price tag. What are some of the cost advantages to the system you're using?
JF: In our case, the high price tag typically associated with proton therapy was not an issue. While I can't share specific numbers, I can say that the capital cost of the equipment was very manageable. Our primary focus was on the cost of operation, and the system we use offers significant advantages in this regard. It doesn't require disposables and consumes very little electricity, which keeps operational costs low. Additionally, unlike many alternative systems that require nightly maintenance, our system demands minimal upkeep, further reducing long-term expenses.

AP: Another significant advantage is that the system fits into a conventional LINAC vault with some retrofitting. This is a big deal because it reduces our operational risks, allowing us to offer proton therapy to all eligible patients without logistical hurdles now and in the future.

HCB News: Are there things that can be done with conventional gantry-based systems that you're not currently able to do?
JF: I don't believe there are any limitations with our current system compared to conventional gantry-based systems. In fact, I would argue the opposite is true. Our system offers greater accuracy in patient positioning and leverages advanced technology that allows us to apply fields that were previously unachievable with traditional gantry systems. However, we acknowledge that we're continuously learning, and there may be situations where certain patients might need to be turned away. That said, Hadassah is a comprehensive cancer care institution, equipped with all the necessary tools to fight cancer effectively.

HCB News: Looking ahead, what goals do you have for the proton therapy facility at Hadassah?
AP: Looking ahead, our goals for the proton therapy facility at Hadassah include expanding the range of regions we treat and increasing the number of patients we can accommodate. We also aim to demonstrate advanced techniques such as gated dynamic arc therapy and real-time adaptive therapy. Additionally, we plan to support P-Cure in bringing new technologies to the market, including the development of helium therapy, which holds great potential for improving cancer treatment outcomes.